Published online by Cambridge University Press: 20 January 2009
The objective of this article is to analyse the way in which budget allocation decisions have been made in the National Health Service (NHS) of Britain. Despite the criticisms of the pre-1948 health care system on the grounds of geographical inequity, it was not until nearly twenty-five years after the service's inception that explicit allocation formulae were devised and implemented in an attempt to achieve equity, defined as equal financial resources for health care for those in equal need.
The article is divided into four sections; the first analyses briefly the establishment of the NHS in 1948 and the failure of policy-makers to rectify the significant inequalities in the distribution of health care inputs between the regions. The second section is concerned with the official recognition of the policy problem of geographical inequality in resources and the first attempt to rectify it. In the third section the most recent set of resource allocation formulae for England, Scotland and Wales will be analysed and compared. The final section offers some brief conclusions.
1 See Eckstein, H., The English Health Service, Harvard University Press, Cambridge, Massachusetts, 1964, p. 19.Google Scholar
2 See Lees, D. S. and Cooper, M. H., ‘Fee per Item of Service: Manchester and Salford, 1913–1928’, Medical Care, 2:3 (1964).Google Scholar
3 See Enquiry into the Cost of the National Health Service (Guillebaud Report), Cmd 9663, HMSO, London, 1956, p. 63.Google Scholar
5 The National Health Service Bill: A Summary of the Proposed Service, Ministry of Health, Cmd 6761, HMSO, London, 1946, p. 3.Google Scholar
6 See ‘Selection of Patients for Dialysis and Transplantation’, British Medical Journal, 2 (1978), 1,449–50.Google Scholar
8 Enquiry into the Cost of the National Health Service.
10 See A Hospital Plan for England and Wales, Ministry of Health, Cmd 1604, HMSO, London, 1962.Google Scholar
11 See The Hospital Building Programme: A Revision of the Hospital Plan for England and Wales, Ministry of Health, Cmnd 3000, HMSO, London, 1966.Google Scholar
13 See Cooper, M. H. and Culyer, A. J., ‘An Economic Assessment of Some Aspects of the Organisation of the National Health Service’, in British Medical Association, Health Services Financing, report of a committee chaired by I. Jones, 1970Google Scholar, Appendix A; Cooper, M. H. and Culyer, A. J., ‘An Economic Survey of the Nature and Intent of the British National Health Service’, Social Science and Medicine, 5 (1971), 1–13CrossRefGoogle ScholarPubMed; and Cooper, M. H. and Culyer, A. J., ‘Equality in the National Health Service: Intentions, Performance and Problems in Evaluation’, in Hauser, M. (ed.), The Economics of Medical Care, Allen and Unwin, London, 1972.Google Scholar
16 Regional Resource Allocation Formula, first interim report of the RAWP, DHSS, HMSO, London, 1975.Google Scholar
17 Sharing Resources for Health in England, report of the RAWP, DHSS, HMSO, London. 1976.Google Scholar
18 See Buxton, M. J. and Klein, R. E., ‘Distribution of Hospital Provision: Policy Themes and Resource Variations’, British Medical Journal, 1 (1975), 345–9CrossRefGoogle ScholarPubMed; Rickard, J. H., ‘Per Capita Expenditure of the English AHAs’, British Medical Journal, 1 (1976), 299–300CrossRefGoogle Scholar; and Jones, D. R. and Masterman, S., ‘NHS Resources: Scales of Variation’, British Journal of Preventive and Social Medicine, 30 (1976), 244–50.Google ScholarPubMed
19 See Sharing Resources for Health in England, para. 6:22.
26 See Buxton, M. J. and Klein, R. E., Allocating Health Resources: A Commentary on the Report of the RAWP, Research Paper no. 3, Royal Commission on the National Health Service, HMSO, London, 1978.Google Scholar
27 See Lyons, H., ‘Unless the Sums are Right the Answers will be Wrong’, Pulse, 27 01 1979.Google Scholar
28 See Fox, P. D., ‘Managing Health Resources: English Style’, in McLachlan, G. (ed.), By Guess or By What?, Nuffield Provincial Hospitals Trust, London, 1978.Google Scholar
31 Priorities for Health and Personal Social Services in England, DHSS, HMSO, London, 1976.Google Scholar
33 See Forbes, J. F., Capital Valuation and the Health Services: A Review of Theory and Practice, Discussion Paper no. 01:79, Health Economics Research Unit, University of Aberdeen, 1979.Google Scholar
37 See Forsyth, G. and Varley, R., Resource Allocation Subregionally: The Impact in the North Western RHA, mimeograph, 1978.Google Scholar
38 Scottish Health Authorities Revenue Equalisation, Report of the Working Party on Revenue Resource Allocation, Scottish Home and Health Department, HMSO, Edinburgh, 1977.Google Scholar
41 Report of the Steering Committee on Resource Allocation in Wales, Welsh Office, HMSO, Cardiff, 1977.Google Scholar
42 The Distribution of Resources to Health Authorities in Wales: Third Report of the Steering Committee, Welsh Office, 1979.Google Scholar
43 Details of sources and calculations are available from the authors.
44 Report of the Steering Committee on Resource Allocation in Wales, para. 5:12.
45 As in Priorities for Health and Personal Social Services in England.
46 Report of the Royal Commission on the National Health Service, Cmnd 7615, HMSO, London, 1979.Google Scholar
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